Original Research Early Mobilization in Critically Ill Patients: Patients’ Mobilization Level Depends on Health Care Provider’s Profession Jaime Garzon-Serrano, MD, Cheryl Ryan, RN, Karen Waak, DPT, Ronald Hirschberg, MD, Susan Tully, RN, Edward A. Bittner, MD, PhD, Daniel W. Chipman, BS, RRT, Ulrich Schmidt, MD, PhD, Georgios Kasotakis, MD, John Benjamin, MD, Ross Zafonte, DO, Matthias Eikermann, MD, PhD Objective: To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists. Design: Prospective, observational study. Setting: Twenty-bed surgical intensive care unit (SICU) of the Massachusetts General Hospital. Participants: Sixty-three critically ill patients. Methods: Physical therapists and nurses performed 179 mobilization therapies with 63 patients. Outcome Measurement: Mobilization was defined as the process of enhancing mo- bility in the SICU, including bed mobility, edge of bed activities, transfers out of bed to a chair, and gait training; the mobilization level was measured on the SICU optimal mobili- zation scale, a 5-point (0-4) numerical rating scale. Results: Patients’ level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses (2.3  1.2 mean  SD versus 1.2  1.2, respectively P  .0001). Different barriers for mobilization were identified by physical therapists and nurses: hemodynamic instability (26% versus 12%, P = .03) and renal replacement therapy (12% versus 1%, P = .03) were barriers rated higher by nurses, whereas neurologic impairment was rated higher by physical therapists providers (18% versus 38%, P = .002). No mobilization- associated adverse events were observed in this study. Conclusions: This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses. Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients. PM R 2011;3:307-313 INTRODUCTION Immobility due to prolonged bed rest in the intensive care unit (ICU) plays an important role in the development of ICU-acquired weakness [1-3]. There is evidence to indicate that skeletal muscle strength may decline by 1%-1.5% per day of strict bed rest [4] and 4%-5% for each week of bed rest [5], which leads to a 10% reduction in postural muscle strength after 1 week of complete bed rest [6]. Immobilization is associated with substantial morbidity and may affect the rate of recovery and return to the patient’s former level of function after critical illness and ICU treatment [2,7]. Investigators have even described the feasibility and potential benefits of mobilizing patients in the ICU and those who are being mechanically ventilated [3,8-10]. Siebens et al [11] show that an exercise program begun during hospitalization and continued afterward results in improved function in instrumental activities of daily living 1 month after hospitalization compared with that observed with usual care [11]. Prospective studies have reported improved functional outcome with early mobilization of critically ill patients in a Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org This work was supported by funds from the Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medi- cine, Boston, MA. Submitted for publication July 30, 2010; accepted December 30. Author affiliations and disclosures are pro- vided at the end of the article. PM&R © 2011 by the American Academy of Physical Medicine and Rehabilitation 1934-1482/11/$36.00 Vol. 3, 307-313, April 2011 Printed in U.S.A. DOI: 10.1016/j.pmrj.2010.12.022 307